Systems, devices, and related methods for laser lithotripsy

ABSTRACT

In one aspect of the present disclosure, a laser fiber may include an optical fiber. The optical fiber may include a proximal portion. The optical fiber also may include a distal portion having a distal end. The optical fiber may be configured to transmit laser energy from the proximal portion to the distal portion for emission of the laser energy from the distal end. The optical fiber also may include a distal tip surrounding the distal portion to protect the distal portion. The distal tip may include a sheet glass material having a laser energy emitting surface. The laser energy emitting surface may be defined by a chemically-strengthened surface layer.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority from U.S. ProvisionalApplication No. 62/374,411, filed on Aug. 12, 2016, the entirety ofwhich is incorporated by reference herein.

TECHNICAL FIELD

Various aspects of the present disclosure relate generally to treatingsubjects using lasers. More specifically, the present disclosure relatesto systems, devices, and related methods for laser lithotripsy.

BACKGROUND

Lasers have been used in, for example, urology, neurology,otorhinolaryngology, general anesthetic ophthalmology, dentistry,gastroenterology, cardiology, gynecology, thoracic, and orthopedicprocedures. More specifically, these procedures may entail the deliveryof laser energy as part of treatment protocols. One example of aprocedure that may be performed using a laser is lithotripsy.Lithotripsy involves treating a subject's kidneys, ureters, or bladderby removing material therein, such as calculi or stones. Laserlithotripsy is a subset of lithotripsy where laser energy is applied tobreak down the material, thereby facilitating removal of the material.In one exemplary laser lithotripsy procedure, a laser fiber may beinserted through the working channel of an introducer, such as anendoscope, to the targeted material. The laser fiber may emit laserenergy at the targeted material to break down the targeted material intopieces. The pieces may be washed out of, or otherwise removed from, thesubject.

The laser fiber may be placed in contact with, or nearly in contactwith, the targeted material prior to the application of the laserenergy. The targeted material may, in some instances, be in contact withwater. Since the water also may absorb the laser energy, the water maybe affected by the laser energy intended for the targeted material. Forexample, the laser energy absorbed by the water may produce shockwavesin the water. The shockwaves may damage the laser fiber. Such damage mayreduce the amount of laser energy emitted from the laser fiber. Fixingthe damage by, for example, cleaving the damaged portion of the laserfiber, and then re-inserting the laser fiber into subject to continuewith a procedure, may increase the time and cost associated withperforming the procedure.

Another challenge associated with laser lithotripsy is that differentlysized laser fibers may be used, with the laser fiber size being selectedbased on the location of the targeted material in the subject. Forexample, a laser fiber having a smaller core size may be selected toreach material in a subject's lower kidney pole. One reason for thisselection is that the laser fiber with the smaller core size may be bentto form a tighter curve than an laser fiber having a larger core size,making it easier to maneuver the laser fiber with the smaller core sizeinto the target area. The laser fiber having the smaller core size may,however, be used with the same laser generator as the laser fiber havingthe larger core size. If the core size of the laser fiber is smallerthan that of focused laser energy generated by the laser generator,and/or if the focused laser energy delivered from the laser generator tothe core is misaligned or greater than the optical fiber's acceptanceangle, errant laser energy may be transferred to components outside ofthe core, possibly damaging those components and negatively impactingthe performance of the laser fiber.

Solutions that can deliver laser energy to targeted material, whilereducing or eliminating the occurrence of the above-described drawbacks,may lead to better outcomes for users and subjects.

SUMMARY

Aspects of the disclosure relate to, among other things, systems,devices, and related methods for laser lithotripsy. Each of the aspectsdisclosed herein may include one or more of the features described inconnection with any of the other disclosed aspects.

In one aspect of the present disclosure, a laser fiber may include anoptical fiber. The optical fiber may include a proximal portion. Theoptical fiber also may include a distal portion having a distal end. Theoptical fiber may be configured to transmit laser energy from theproximal portion to the distal portion for emission of the laser energyfrom the distal end. The optical fiber also may include a distal tipsurrounding the distal portion to protect the distal portion. The distaltip may include a sheet glass material having a laser energy emittingsurface. The laser energy emitting surface may be defined by achemically-strengthened surface layer.

Aspects of the laser fiber may include one or more of the featuresbelow. The laser energy emitting surface may be a distal-facing surface.The sheet glass material also may include a proximal-facing surface thatfaces the distal end of the distal portion of the optical fiber. Thedistal tip may include a tubular member concentrically surrounding thedistal portion of the optical fiber. The tubular member may include apassage that receives the distal portion of the optical fiber. Thetubular member may have a distal end opening. The distal end opening maybe covered by the sheet glass material. The sheet glass material may becoupled to the tubular member by an epoxy. The tubular member may becoupled to the optical fiber by an epoxy. A proximal end of the tubularmember may taper down in a proximal direction. A lens member may belocated between the distal end of the optical fiber and the sheet glassmaterial. The lens member may include a gradient index lens. Thegradient index may be configured to focus the laser energy. The sheetglass material may include a tubular portion concentrically surroundingthe distal portion of the optical fiber. A distal end face of theoptical fiber may have a curvature.

In another aspect of the present disclosure, a laser fiber may includean optical fiber. The optical fiber may include a proximal portion. Theoptical fiber also may include a distal portion having a distal end. Theoptical fiber may be optically transmissive to transmit laser energyfrom the proximal portion to the distal portion for emission of thelaser energy from the distal end. The optical fiber also may include adistal tip surrounding the distal portion. The distal tip may include asheet glass material having a laser energy emitting surface. The laserenergy emitting surface may be stronger than the distal end of theoptical fiber.

Aspects of the laser fiber may include one or more of the featuresbelow. The distal tip may include a tubular member concentricallysurrounding the distal portion of the optical fiber. The sheet glassmaterial may cover a distal end of the tubular member. The sheet glassmaterial may be stronger than material forming the tubular member.

In another aspect of the present disclosure, a laser fiber may includean optical fiber configured to transmit energy. The optical fiber mayinclude a core. The optical fiber also may include claddingconcentrically surrounding at least a portion of the core. The opticalfiber also may include a distal portion including a coveringconcentrically surrounding the cladding. The optical fiber also mayinclude a proximal portion free of the covering. At least a portion ofthe cladding at the proximal portion may be diffused. The laser fiberalso may include a connector configured to couple the optical fiber to alaser generator. The connector may include a tubular member having apassage that receives the proximal portion of the optical fiber. Theconnector also may include a holder having a passage that (i) receivesthe tubular member, such that the holder concentrically surrounds aportion of the tubular member, and (ii) receives the distal portion ofthe optical fiber. The connector also may include a couplerconcentrically surrounding the tubular member, the diffused claddingallowing laser energy in the cladding to leave the optical fiber andconvert into heat energy within the tubular member, with at least someof the heat energy being dissipated by the tubular member, holder, andcoupler before reaching the distal portion of the optical fiber.

Aspects of the laser fiber may include one or more of the featuresbelow. A first epoxy may couple the distal portion of the optical fiberto the holder. A second epoxy may couple the holder to the coupler. Thefirst epoxy may have a lower thermal conductivity than the second epoxy.

It may be understood that both the foregoing general description and thefollowing detailed description are exemplary and explanatory only andare not restrictive of the invention, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate exemplary aspects of the presentdisclosure and together with the description, serve to explain theprinciples of the disclosure.

FIG. 1 shows a schematic diagram of a system for laser lithotripsy, inaccordance with aspects of the present disclosure.

FIG. 2 shows a cross-sectional view of a laser fiber, in accordance withaspects of the present disclosure.

FIG. 3 shows a cross-sectional view of another laser fiber, inaccordance with aspects of the present disclosure.

FIG. 4 shows a cross-sectional view of yet another laser fiber, inaccordance with aspects of the present disclosure.

FIG. 5 shows a cross-sectional view of yet another laser fiber, inaccordance with aspects of the present disclosure.

FIG. 6 shows a cross-sectional view of a laser fiber connector, inaccordance with aspects of the present disclosure.

DETAILED DESCRIPTION

The present disclosure is drawn to systems, devices, and methods forlaser lithotripsy. Reference will now be made in detail to aspects ofthe present disclosure, examples of which are illustrated in theaccompanying drawings. Wherever possible, the same or similar referencenumbers will be used through the drawings to refer to the same or likeparts. The term “distal” refers to a portion farthest away from a userwhen introducing a device into a patient. By contrast, the term“proximal” refers to a portion closest to the user when placing thedevice into the patient. As used herein, the terms “comprises,”“comprising,” or any other variation thereof, are intended to cover anon-exclusive inclusion, such that a process, method, article, orapparatus that comprises a list of elements does not include only thoseelements, but may include other elements not expressly listed orinherent to such process, method, article, or apparatus. The term“exemplary” is used in the sense of “example,” rather than “ideal.” Asused herein, the terms “about,” “substantially,” and “approximately,”indicate a range of values within +/−5% of a stated value.

FIG. 1 is a schematic diagram of an exemplary laser treatment system100. System 100 may include a laser fiber 102, a laser generator 104that may generate laser energy 106, and a waveguide 108 opticallycoupling laser generator 104 to laser fiber 102. It is contemplated thatlaser fiber 102 and waveguide 108 may be parts of a singular elongatemember, or alternatively, different parts joined together. Laser fiber102 and waveguide 108 may be cylindrical. System 100 also may include aprobe 110, in which at least a distal end of laser fiber 102 may besupported. Laser energy 106 may be discharged from a distal end of laserfiber 102 at a targeted material within a subject, as part of atreatment or other medical procedure. Examples of treatments/medicalprocedures may include tissue ablation; fragmentation of kidney,ureteral, or bladder calculi; and/or fragmentation of kidney, ureteral,or bladder stones.

FIG. 2 shows a cross-sectional view of laser fiber 102, and inparticular, a distal end 202 of laser fiber 102. Laser fiber 102 mayinclude an optical fiber 212, a covering 214, and a fiber tip 216.Optical fiber 212 may include, for example, a central core 215, with atleast a portion of central core 215 being surrounded by a concentriccladding 217. Central core 215 may be at least partially formed ofsilica (e.g., quartz glass, amorphous silicon dioxide, or any othersimilar light transmissive materials), either in pure form or includingone or more dopants. Cladding 217 may be made of a material that has alower refractive index than central core 215 to assist with confininglaser energy to central core 215. This may facilitate the delivery oflaser energy 106 through central core 215 via total internal reflectionwithin central core 215. Optical fiber 212 may include a distal portion218 terminating at a distal end face 220. Laser energy 106 may beemitted from distal end face 220 toward a targeted material 233.

Covering 214 may include one or more concentric layers of materialsurrounding optical fiber 212. For example, covering 214 may include apolymer jacket or sheath surrounding cladding 217. The polymer jacket orsheath may be made of acrylate. Additionally or alternatively, covering214 may include a buffer layer made of resin. Covering 214 may offermechanical protection and/or support to optical fiber 212. A distal end219 of covering 214 may be proximal distal portion 218 of optical fiber212, such that distal portion 218 may protrude distally from distal end219 of covering 214.

Distal portion 218 of optical fiber 212 may be encased within,surrounded by, or otherwise received within fiber tip 216. Fiber tip 216may be configured to protect distal portion 218. For example, fiber tip216 may prevent or reduce damage to distal portion 218 that wouldotherwise occur due to contact between distal portion 218 and targetedmaterial 233, and/or due to close proximity of distal portion 218 totargeted material 233, during treatment.

Fiber tip 216 may include a tubular member 222. Tubular member 222 mayinclude, for example, a fused silica tube. Tubular member 222 mayinclude a proximal portion 224 with an outer diameter that decreasesalong a proximal direction. The outer diameter of tubular member 222may, for example, taper down as tubular member 222 approaches covering214. The change in outer diameter may result in a proximal end 221 oftubular member 222 having an outer diameter substantially equal to anouter diameter of distal end 219 of covering 214.

Tubular member 222 may include a passage 226 terminating at an opening228. Opening 228 may be covered by a shielding member 230. Shieldingmember 230 may be a circular window. Shielding member 230 may have adistal-facing surface 225 and a proximal-facing surface 227. Shieldingmember 230 may be made of, for example, a chemically-strengthenedaluminosilicate sheet glass, such as GORILLA GLASS, GORILLA GLASS 2,GORILLA GLASS 3, or GORILLA GLASS 4 from CORNING. An exemplarycomposition may include an alkali aluminosilicate glass having 66.4 mol% SiO₂; 10.3 mol % Al₂O₃; 0.60 mol % B₂O₃; 4.0 mol % Na₂O; 2.10 mol %K₂O; 5.76 mol % MgO; 0.58 mol % CaO; 0.01 mol % ZrO₂; 0.21 mol % SnO₂;and 0.007 mol % Fe₂O₃.

The chemical strengthening may include strengthening by ion exchange.Sheet glass material may be immersed in a molten alkaline potassium saltat a high temperature, wherein smaller sodium ions in the sheet glassmaterial may be replaced by larger potassium ions from the salt bath.Because the larger potassium ions occupy more volume than the smallersodium ions, they create a surface layer of high residual compressivestress at distal-facing surface 225 and/or proximal-facing surface 227,leaving material between those surfaces protected and under a reducedtensile stress load. These characteristics provide shielding member 230with strength (e.g., the ability to withstand an applied load withoutfailure or plastic deformation), an ability to contain flaws, andoverall crack-resistance beyond that of other glass materials. Thestrength of shielding member 230 may, for example, exceed that oftubular member 222 and/or distal portion 218 of optical fiber 312.Accordingly, shielding member 230 may be highly resistant to beingdamaged. Alternatively, shielding member 230 may include any othersuitable strengthened, toughened, or reinforced sheet glass. Shieldingmember 230 may be stronger and/or tougher than distal portion 218 ofoptical fiber 212 and/or tubular member 222.

In one example, a recess 232 may be formed in a distal end face 223 oftubular member 222. Recess 232 may be annular, and may extend aroundpassage 226. Recess 232 may receive shielding member 230. Recess 232 maybe sized such that distal-facing surface 225 of shielding member 230 maybe substantially flush with distal end face 223 of tubular member 222.Alternatively, shielding member 230 may cover the entirety of distal endface 223.

Shielding member 230 may be coupled to tubular member 222 using an epoxy229 or any other suitable adhesive. Tubular member 222 also may becoupled to covering 214 and/or distal portion 218 of optical fiber 212by an epoxy 231 or any other suitable adhesive. Epoxy 229 and/or epoxy231 may be introduced in liquid form, and may be cured thereafter byexposure to ultraviolet light.

Fiber tip 216 may form a sealed cavity 234 around distal portion 218 ofoptical fiber 212. Sealed cavity 234 may be filled, for example, withair. Distal portion 218 of optical fiber 212 may be centered withinsealed cavity 234 and/or tubular member 222, such that a predetermineddistance or spacing is provided between an interior surface of tubularmember 222 and an exterior surface of optical fiber 212. Additionally oralternatively, distal end face 220 of optical fiber 212 may be spacedfrom proximal-facing surface 227 of shielding member 230. Predetermineddistances or spacing may be set to alleviate or otherwise limit damageto distal portion 218 of optical fiber 212 during use, manipulate (e.g.,focus or diffuse) a shock wave generated during use, and/or improveablation efficiency. According to one exemplary usage, shielding member230 may be positioned in contact with targeted material 233, or at adistance about 2 mm or less from material 233. Even at such a closerange, the physical properties of shielding member 230 may allow it toremain capable of protecting distal portion 218 of optical fiber 212from being damaged.

Laser energy 106 may be produced by laser generator 104 (FIG. 1.). Lasergenerator 104 may include one or more laser sources, such as laserresonators, that produce laser energy 106. In one example, lasergenerator 104 may produce laser energy 106 in the form of a pulse trainor continuous wave. Laser generator 104 may include Q-switched laserrods to produce laser energy 106, such as, for example, a holmium dopedyttrium aluminum garnet (Ho:YAG) laser rod, a thulium doped yttriumaluminum garnet (Tm:YAG) laser rod, or other laser rod suitable forproducing laser energy 106. Laser energy 106 may have a power ofapproximately 1-50 W, a pulse repetition frequency of about 1 to about2000 Hz, and an energy level of about 1 mJ to about 5 J. While someexamples are described here, it should be understood that laser energy106 having other parameters also may be used. It is contemplated thatdistal end face 220 of optical fiber 212 and/or proximal-facing surface227 of shielding member 230 may be coated with an anti-reflectivecoating to enhance transmission of laser energy 106 by distal end face220 and/or proximal-facing surface 227. Alternatively, theanti-reflective coating may be omitted as long as the resultingreduction in transmission is acceptable to the user.

FIG. 3 shows a cross-sectional view of a distal end of another laserfiber 302. Laser fiber 302 may be used in laser treatment system 100(FIG. 1). For example, laser fiber 302 may replace laser fiber 102 orlaser fiber 102 (FIG. 2). Laser fiber 302 may include an optical fiber312 and a fiber tip 316 similar to corresponding components of laserfiber 102. It is contemplated that laser fiber 302 may be nearlyidentical to laser fiber 102. Some of the components of laser fiber 302that are not numbered and/or are not described here may correspond tosimilar components of laser fiber 102, and descriptions of thosecomponents are not reiterated here for the sake of brevity. A similarapproach has been taken with respect to the other figures that will bedescribed below.

One difference between laser fibers 102 and 302 is that laser fiber 302may include a lens member 336. Lens member 336 may be received within atubular member 322 of fiber tip 316. For example, lens member 336 may bepositioned within a proximal portion of a sealed cavity 334 between adistal end face 320 of optical fiber 312 and a proximal-facing surface327 of a shielding member 330 of fiber tip 316. Lens member 336 may besecured to an interior surface of tubular member 322 by an epoxy 338,which may be one cured by exposure to ultraviolet light. Additionally oralternatively, lens member 336 may be secured to proximal-facing surface327 by a similar or identical epoxy (not shown).

Lens member 336 may include, for example, a gradient index lens.Gradient index lenses may feature plane optical surfaces (e.g., opticalsurfaces 340 and 342) and may achieve focus via a substantiallycontinuous change of the refractive index within the lens materialinstead of through the use of curved optical surfaces. As such, gradientindex lenses may be suited for use in assemblies where a lens shouldhave a specific working distance. It is contemplated that lens member336 may be selected from a number of gradient index lenses that havesimilar or identical shapes, but different optical properties based ontheir refractive index profiles.

In one example, lens member 336 may have a positive focusing power suchthat it may condense laser energy 306. This may result in more laserenergy 306 being concentrated on a smaller area of a targeted material333. The concentration of laser energy 306 may increase the overallenergy delivered to targeted material 333, thereby speeding up treatmenttimes, allowing harder materials to be broken down, and/or giving theuser precise control over aiming of laser energy 306. It is contemplatedthat the refractive index gradient of lens member 336 may be selected toset a focal length, such that laser energy 306 may be focused apredetermined distance from a distal-facing surface 325 of shieldingmember 330. The predetermined distance may be, for example, about 2 mmor less from distal-facing surface 325. The predetermined distance maybe increased or decreased as desired. Increasing the distance maydecrease the likelihood of optical fiber 312 and/or lens member 336being damaged during use, while decreasing the distance may increase apower of the emitted laser energy 306.

Additionally or alternatively, lens member 336 may be configured toinfluence laser energy 306 in other ways. For example, lens member 336may have a refractive index gradient that may result in a negativefocusing effect, such that lens member 336 may disperse laser energy 306as laser energy 306 is emitted. In other words, lens member 336 may havethe effect of a concave lens. This may be useful when using laser energy306 to ablate tissue. It is also contemplated that lens member 336 mayhave a refractive index gradient that may cause the emission of laserenergy 306 at an angle relative to a central longitudinal axis of lensmember 336. This may, for example, allow laser energy 306 to be directedat target areas/materials that may not be accessible to the proximal endface of laser fiber 302.

FIG. 4 shows a cross-sectional view of a distal end of another laserfiber 402. Laser fiber 402 may be used in laser treatment system 100(FIG. 1). For example, laser fiber 402 may replace any of laser fibers102 and 302. It is contemplated that laser fiber 402 may be nearlyidentical to any of the aforementioned laser fibers. Laser fiber 402 mayinclude an optical fiber 412 and a fiber tip 416, each of which may besimilar to any of the aforementioned optical fibers and fiber tips,respectively. One difference is that optical fiber 412 may have a shapeddistal end face 420. The shaping may allow distal end face 420 to act asa lens or collimator useful for controlling, for example, Fresnel loss,depth of focus, convergence/divergence of laser energy 406, and spotsize of laser energy 406 emitted by optical fiber 412, without requiringmounting a separate lens or other member at or near distal end face 420.

As shown in FIG. 4, distal end face 420 may be sculpted to be convexrather than flat, allowing distal end face 420 to act as a convex lens.As such, distal end face 420 may have a positive focusing power suchthat it may condense laser energy 406 as laser energy 406 is emitted.This may result in more laser energy 406 being concentrated on a smallerarea of targeted material 433. The concentration of laser energy 406 mayincrease the overall energy delivered to the targeted material 433,thereby speeding up treatment times, allowing harder materials to beprocessed, and giving the user precise control over aiming of laserenergy 406. It is contemplated that the shape of distal end face 420 maybe selected to set a focal length of distal end face 420, such thatlaser energy 406 may be focused a predetermined distance from distal endface 420. The predetermined distance may be, for example, about 2 mm orless from a distal-facing surface 425 of a shielding member 430 of fibertip 416. The predetermined distance may be increased or decreased asdesired. Increasing the distance may decrease the likelihood of opticalfiber 412 being damaged during use, while decreasing the distance mayincrease a power of the emitted laser energy 406. While shaping distalend face 420 may weaken the distal end of optical fiber 412 by, forexample, thinning the distal tip of optical fiber 412, the protectionafforded by shielding member 430 may protect the distal tip, therebycompensating for any weakness.

Additionally or alternatively, optical fiber 412 may be shaped toachieve other effects. For example, a distal end portion may include adown-taper (not shown), which may decrease the spot size of emittedlaser energy 406 and/or increase divergence. It is also contemplatedthat distal end face 420 may have a concave shape, thereby acting as aconcave lens for increasing the divergence of emitted laser energy 406.It is also contemplated that distal end face 420 may be flat, butangled, to redirect laser energy 406 sideways, or at least at an anglethat may reduce back reflection associated with distal end face 420.

FIG. 5 shows a cross-sectional view of a distal end of another laserfiber 502. Laser fiber 502 may be used in laser treatment system 100(FIG. 1). For example, laser fiber 502 may replace any of theaforementioned laser fibers. Laser fiber 502 may include an opticalfiber 512 similar to any of the aforementioned optical fibers. It iscontemplated that optical fiber 512 may be, for example, identical tooptical fiber 412. Laser fiber 502 may differ from the aforementionedlaser fibers in that a fiber tip 516 of laser fiber 502 may have asingular or monolithic construction. Each of fiber tips 216, 316, and416 may be constructed by coupling a shielding member to a tubularmember. Fiber tip 516, on the other hand, may be one continuous piecehaving a tubular portion 522 and a shielding portion 530. Tubularportion 522 and shielding portion 530 may be made of the same materialas shielding member 130, but may be manufactured in a manner that formsthe material into a three-dimensional shape, rather than a planar orplate-like shape. Alternatively, a multi-part fiber tip also iscontemplated, similar to fiber tips 216, 316, and 416, where shieldingmembers 130, 230, and 330 may be replaced with a curved (e.g., at leastpartially convex or concave) or other three-dimensionally shapedshielding member.

As shown in laser treatment system 100 of FIG. 1, waveguide 108 mayinclude a connector 140 at its proximal end. Connector 140 may beremovably coupled to laser generator 104. Laser generator 104 mayinclude, for example, a connector coupler (not shown) for removablycoupling with connector 140. The connector coupler may include aSubminiature version A (SMA) coupler. The coupler may include aplate-like proximal base portion, and an externally-threaded cylindricalportion extending distally from the base portion. Laser generator 104may generate laser energy 106 in the form of a laser beam that may bedirected down a center of the coupler.

Aspects of an exemplary connector 640, which may be used as connector140, are shown in FIG. 6. Connector 640 may include a coupler 642 havingan internally-threaded nut 643. Coupler 642 may be, for example an SMAcoupler complementary to the SMA coupler of laser generator 140. Coupler642 may be made of stainless steel or any other suitable material.Coupler 642 may be screwed onto and screwed off of the coupler of lasergenerator 104 for attaching connector 640 to and detaching connector 640from laser generator 104.

Connector 640 may include a ferrule 644. Ferrule 644 may be made ofsilica or any other suitable material. Ferrule 644 may be received in acavity 646 of coupler 642. Ferrule 644 may be centered relative tocoupler 642 in cavity 646. Ferrule 644 may be an elongate hollow body648 having a passage 650 extending therethrough into which is inserted aproximal end 650 of an optical fiber 612. Optical fiber 612 may besimilar to any of the aforementioned optical fibers. Passage 650 mayinclude a down-taper at a proximal end, and an up-taper at a distal end.A proximal end 652 of ferrule 644 may be supported in an opening 654 ina flange 656 at a proximal end 655 of ferrule 644.

Connector 640 also may include a holder 658. Holder 658 may be made ofaluminum or any other suitable material. Holder 658 may include aproximal portion 660 and a distal portion 662. Proximal portion 660 mayhave a larger diameter than distal portion 662. Proximal portion 660 maybe coupled to a distal end 659 of coupler 642 by an epoxy 661 or anyother suitable adhesive.

A distal end 656 of ferrule 644 may be supported by holder 658. Holder658 may be hollow, and may have a passage 664 extending therethrough.Passage 664 may have a proximal region 666, a distal region 668, and anintermediate region 670 between proximal and distal regions 666 and 668.Proximal region 666 may be in proximal portion 660, and may have alarger diameter than intermediate and distal regions 668 and 670.Proximal region 660 may receive distal end 656 of ferrule 644. In oneexample, an outer surface of distal end 656 may be adhered to an innersurface of proximal portion 660 by an epoxy 672 or other suitableadhesive. Epoxy 672 may include a novolac epoxy resin, such as one thatcontains epoxy phenol novolac, like EPO-TEK 353ND from EPDXY TECHNOLOGY.Intermediate region 670 may have a smaller diameter than proximal anddistal regions 666 and 668, and may receive optical fiber 612. Covering614 may not be present around the portion of optical fiber 612 inintermediate region 670, or around portions of optical fiber 612proximal to intermediate region 670. Distal region 668 may be in distalportion 662, and may have a smaller diameter than proximal region 666and a larger diameter than intermediate region 670. Distal region 668may receive a portion of a laser fiber 602 that includes optical fiber612 and a covering 614 concentrically surrounding optical fiber 612. Theportion of laser fiber 602 may be seated in distal region 668 and heldin place by use of an epoxy 674 or other suitable adhesive. Epoxy 674may have a lower thermal conductivity than epoxy 661. Accordingly, heatgenerated in holder 658 may transfer more readily through epoxy 661 andinto coupler 642 than through epoxy 674 and to covering 614.

An extension sleeve 678 may surround a distal portion of coupler 642.Extension sleeve 678 may be press-fit onto the distal portion of coupler642. Extension sleeve 678 may be made of, for example, aluminum.

Laser energy 606 may be directed into optical fiber 612 at a proximalend 676 of optical fiber 612. Laser energy 606 may travel distallythrough optical fiber 612 and through coupler 642, ferrule 644, andholder 658, on its way to a distal end (not shown) of optical fiber 612,for emission from the distal end onto a targeted material (not shown).

In some instances, laser generator 104 (FIG. 1) may typically be used toprovide laser energy 106 to a laser fiber having a fiber core with aparticular diameter, or a diameter within a particular range ofdiameters. However, in order to perform procedures in areas of a subjectthat may be difficult to access, the user may disconnect the laser fiberfrom laser generator 104, and may connect a laser fiber having a centralcore with a smaller diameter. In such a scenario, laser energy 106launched from laser generator 104 may be too large for the smallercentral core. As a result, some laser energy may couple into thecladding surrounding the smaller central core. Then, when the laserfiber is bent to access the target area, the laser energy in thecladding may leak into the covering surrounding the optical fiber. Thecovering, which may include, for example, acrylate, may absorb theleaked laser energy and generate heat. The covering and the opticalfiber, when heated, may expand at different rates. An acrylate coating,for example, may expand about 200 times faster than a fused silica fibercore with cladding. The covering may break due to the stress along thelongitudinal axis of the laser fiber. When the temperature rises toabout 260 degrees Celsius, an acrylate coating may decompose. When theacrylate coating is broken (e.g., due to mechanical stress and/orthermal decomposition), there may be insufficient tensile protection onthe optical fiber, and the optical fiber my break. This is one reasonlaser fibers that have smaller diameter cores may have a higher failurerate than other laser fibers.

Connector 640 (FIG. 6) may be configured to address one or more of theabove-described issues. Optical fiber 612 may include a central core 615and concentric cladding 617, with central core 615 having a diametersimilar to that of the aforementioned smaller fiber core. Cladding 617on a portion of optical fiber 612 may be removed. For example, cladding617 may be diffused using a carbon dioxide laser. The portion of opticalfiber 612 with diffused cladding 617 may be inserted into passage 650 offerrule 644, and may be fused with ferrule 644 using the carbon dioxidelaser in a manner similar to that associated with BLACK HOLE TECHNOLOGYof AMERICAN MEDICAL SYSTEMS. A length of the portion of optical fiber612 may be less than a length of passage 650. For example, the portionof optical fiber 612 may be bordered on its proximal and distal sides byportion of optical fiber 612 with full cladding 617. The portions withfull cladding 617 may also be received in passage 650.

Due to the disparity in size between laser energy 106 launched fromlaser generator 104, and the diameter of central core 615, some laserenergy 106 may leak into cladding 617. When laser energy 1096 travelsalong the diffused cladding 617, it may diffuse out of the diffusedcladding 617, and may be dissipated as heat. The heat may be absorbed byferrule 644, coupler 642, holder 658, and/or extension sleeve 678. Epoxy661 may have a higher thermal conductivity than epoxy 674, to helpfacilitate heat transfer from holder 658 into coupler 642 and extensionsleeve 678, instead of from holder 658 into covering 614. With thisdesign, laser energy in cladding 617 may be dissipated by connector 640(as heat) before the laser energy reaches covering 614. Since less heatreaches covering 614, one driving factor in causing breakage of laserfiber 602 during bending may be reduced or eliminated.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the disclosed devices andmethods without departing from the scope of the disclosure. Otheraspects of the disclosure will be apparent to those skilled in the artfrom consideration of the specification and practice of the featuresdisclosed herein. It is intended that the specification and examples beconsidered as exemplary only.

We claim:
 1. A laser fiber, comprising: an optical fiber, including: aproximal portion, and a distal portion having a distal end, the opticalfiber being configured to transmit laser energy from the proximalportion to the distal portion for emission of the laser energy from thedistal end; and a distal tip surrounding the distal portion to protectthe distal portion, the distal tip including a sheet glass materialhaving a laser energy emitting surface, the laser energy emittingsurface being defined by a chemically-strengthened surface layer.
 2. Thelaser fiber of claim 1, wherein the laser energy emitting surface is adistal-facing surface, and the sheet glass material also includes aproximal-facing surface that faces the distal end of the distal portionof the optical fiber.
 3. The laser fiber of claim 1, wherein the distaltip includes a tubular member concentrically surrounding the distalportion of the optical fiber.
 4. The laser fiber of claim 3, wherein thetubular member includes a passage that receives the distal portion ofthe optical fiber.
 5. The laser fiber of claim 3, wherein the tubularmember has a distal end opening, and the distal end opening is coveredby the sheet glass material.
 6. The laser fiber of claim 5, wherein thesheet glass material is coupled to the tubular member by an epoxy. 7.The laser fiber of claim 3, wherein the tubular member is coupled to theoptical fiber by an epoxy.
 8. The laser fiber of claim 3, wherein aproximal end of the tubular member tapers down in a proximal direction.9. The laser fiber of claim 1, further including a lens member locatedbetween the distal end of the optical fiber and the sheet glassmaterial.
 10. The laser fiber of claim 9, wherein the lens memberincludes a gradient index lens.
 11. The laser fiber of claim 10, whereinthe gradient index is configured to focus the laser energy.
 12. Thelaser fiber of claim 1, wherein the sheet glass material includes atubular portion concentrically surrounding the distal portion of theoptical fiber.
 13. The laser fiber of claim 1, wherein a distal end faceof the optical fiber has a curvature.
 14. A laser fiber, comprising: anoptical fiber, including: a proximal portion, and a distal portionhaving a distal end, the optical fiber being optically transmissive totransmit laser energy from the proximal portion to the distal portionfor emission of the laser energy from the distal end; and a distal tipsurrounding the distal portion, the distal tip including a sheet glassmaterial having a laser energy emitting surface, the laser energyemitting surface being stronger than the distal end of the opticalfiber.
 15. The laser fiber of claim 14, wherein the distal tip includesa tubular member concentrically surrounding the distal portion of theoptical fiber, and the sheet glass material covers a distal end of thetubular member.
 16. The laser fiber of claim 15, wherein the sheet glassmaterial is stronger than material forming the tubular member.
 17. Alaser fiber, comprising: an optical fiber configured to transmit energy,including: a core, cladding concentrically surrounding at least aportion of the core, a distal portion including a coveringconcentrically surrounding the cladding, and a proximal portion free ofthe covering, at least a portion of the cladding at the proximal portionbeing diffused; and a connector configured to couple the optical fiberto a laser generator, the connector including: a tubular member having apassage that receives the proximal portion of the optical fiber, aholder having a passage that (i) receives the tubular member, such thatthe holder concentrically surrounds a portion of the tubular member, and(ii) receives the distal portion of the optical fiber, and a couplerconcentrically surrounding the tubular member, the diffused claddingallowing laser energy in the cladding to leave the optical fiber andconvert into heat energy within the tubular member, with at least someof the heat energy being dissipated by the tubular member, holder, andcoupler before reaching the distal portion of the optical fiber.
 18. Thelaser fiber of claim 17, further including a first epoxy coupling thedistal portion of the optical fiber to the holder.
 19. The laser fiberof claim 18, further including a second epoxy coupling the holder to thecoupler.
 20. The laser fiber of claim 19, wherein the first epoxy has alower thermal conductivity than the second epoxy.